European Intensivists Prefer CRRT to Manage Acute Kidney Injury

Most European intensivists prefer to use continuous renal replacement therapy (CRRT) to manage acute kidney injury in critically ill patients, a survey found.

The reasons for preferring CRRT were the perception of better hemodynamic stability, better therapeutic effect resulting from cytokine removal and easier fluid balance control, researchers reported online ahead of print in Intensive Care Medicine.

Matthieu Legrand, MD, of the University of Paris, and colleagues conducted an online survey in which they sent questionnaires to members of the European Society of Intensive Care Medicine. A total of 272 intensivists (218 from Europe and 54 from other continents) responded. They had an average of 12 years of experience in intensive care units. Most (92.6%) were responsible for prescribing renal replacement therapy (RRT). Half reported using both intermittent hemodialysis and CRRT, but most (88%) preferred using CRRT. Additionally, intensivists reported using significantly higher RRT doses in septic than non-septic patients.

The survey showed that respondents most frequently used the “classic criteria” of fluid overload, azotemia, acidosis, and hyperkalemia to decide when to initiate RRT, but the survey revealed for the first time that intensivists also initiate RRT when patients show a urinary output of less than 0.5 mL/kg/hour for at least six hours, according to the researchers.

“Our results provide insight into the motivations of intensivists while presenting the technique that may help in selecting control groups for future trials,” the authors concluded.

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